Effects of knee flexion angle at graft fixation on the outcome of anterior cruciate ligament reconstruction.

Clinical outcome in 44 patients who underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons augmented by the ligament augmentation device for chronic ACL deficiency was studied; average follow-up was 38 months (range, 24 to 52 months). In 19 patients, grafts were fixed with the knees at full extension (group 1), whereas in 25 patients, the grafts were fixed with the knees at 30 degrees of flexion (group 2). The results of subjective testing (Lysholm score), the Lachman test, the pivot-shift test, muscle strength testing, angle of extension loss, and follow-up arthroscopy were compared to assess the effects of flexion angle at fixation on stability and function. The range of motion in group 1 was significantly better than that in group 2. The stability of the knees and the arthroscopic appearance of the grafts in group 1 were, however, significantly worse than those in Group 2.